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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334801218
Report Date: 10/25/2022
Date Signed: 10/25/2022 02:48:12 PM

Document Has Been Signed on 10/25/2022 02:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:LA PETITE ACADEMYFACILITY NUMBER:
334801218
ADMINISTRATOR:WENDY SERNAFACILITY TYPE:
850
ADDRESS:11100 COLLETT AVENUETELEPHONE:
(951) 688-1313
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY: 104TOTAL ENROLLED CHILDREN: 65CENSUS: 52DATE:
10/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:56 PM
MET WITH:Wendy Lopez-Serna,Academy DirectorTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Kay Turner arrived at the facility to conduct a case management visit regarding the lead testing. Per the lead sample report submitted to the Department on or about September 27, 2022, there was a documented level of exceedance in kitchen of 7.0. The fixtures were replaced on Thursday, October 6, 2022, as part of the corrections plan. The Academy Director reported the lead retesting for the sink/faucet in the kitchen is scheduled for October 25, 2022. The sink/faucet in the kitchen has not been in use and will not be in use until it meets the lead requirements. The facility was advised to run the water daily at least 30 seconds at least 4 times per day. The Academy Director reported the sink/faucet is not used for drinking water, as the facility uses bottle water for drinking. The aforementioned resulted in a deficiency, as the documented lead levels exceeded 5.5 ppb and is above the level of exceedance per the Lead Testing Written Directives. Please see 809D for deficiency.

Exit interview conducted and report was reviewed with the Academy Director, Wendy Lopez-Serna.

A copy of this report was provided to the Academy Director and a Notice of Site Visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Karrene Turner
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/25/2022 02:48 PM - It Cannot Be Edited


Created By: Karrene Turner On 10/25/2022 at 02:24 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: LA PETITE ACADEMY
FACILITY NUMBER: 334801218

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
11/11/2022
Section Cited

101700.3

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(b)(1), A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. 
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The fixtures were replaced on 10/06/2022. The restesting is scheduled for 10/25/2022. Upon completion of retest, the results will be submitted to the LPA by POC due date.
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Per the lead sample report submitted on 09/27/2022, sink/faucet in kitchen results were 7.00 UG/L, at the action level of exceedance.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Aaron Ross
LICENSING EVALUATOR NAME:Karrene Turner
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022


LIC809 (FAS) - (06/04)
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